Connecting Climate Change and Health Equity in Public Health Agencies

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode: how climate change impacts some more than others, and a plan to address the connection to equity in Washington State.

UMAIR SHAH:
There is so much work to be done. Let's not get stuck in the left-right dynamic, the political piece where—ultimately, we know public health is political, but we've got to be able to rise above that.

RAD CUNNINGHAM:
There's going to be a pretty massive change in what the public health community is going to be able to do on climate change because of these new opportunities coming up.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we examine what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today: climate change hurts some communities more than others. Its impacts are felt the most in places where people already suffer from hardships that can derail their attempts to get and stay healthy. Across the country, public health leaders are looking for ways to demonstrate the connections between increasingly common natural disasters and the public health of their communities.

Rad Cunningham is an epidemiologist at the Washington State Department of Health. He's along later to tell us how his department is working to make those connections across all of its programs. But first, we hear from Washington's Secretary of Health, Dr. Umair Shah, about the importance of this work and the need to forge ahead through the politics that can often dampen progress.

SHAH:
I'll say, first and foremost, that climate change threatens everybody's health, but it seems to accentuate that impact on certain groups more than others. And that may be those who have less resources to cope and adapt to a changing environment or climate, or maybe people that have less income, people that may be disproportionately impacted by pollution or hazards that are in the environment.

So, when we bring environmental social justice movement together, we oftentimes are really trying to connect not just what's happening in policy and theory, but to communities that are impacted.

JOHNSON:
Given the connections, what have you decided to do about it in Washington State?

SHAH:
Yeah, so you know, whether it goes back to the wildfire smoke or the 2021 heat dome, where we had, unfortunately, 150+ individuals with heat-related deaths and hundreds of hospitalizations, whether it's flooding—whatever the calamity that we've had, our real goal is to, one, make sure that we give the connection of climate and health, to remind everybody that the climate is changing, right. And articulating that change is, I think, the first step is that we've got to continue to remind everybody that it is happening.

And so, when you have an event like a hurricane in the Gulf Coast, or you've got a winter storm, or you've got some extreme drought, that these are not disconnected events. This is exactly what you will start to see with the changing climate—you're going to start to see extreme weather events. And, again, people need to make the connection. What I always love to say is that we've spent a lot of time collecting the dots, it's important for us to spend as much time connecting those dots so people can understand what is happening around them.

And then it's important for us to invest. And it's really about what are the sustainable things that we can do by investing in real environmental-friendly policies. We've already done a lot of that. So, there's a lot of broad support outside even public health. We're just talking about the state itself, the governor and all the state agencies saying, "We are going to do everything we can to take on climate change."

But then, within the Department of Health, it's things like making sure that as part of our work with health equity or anti-racism, environmental justice, that that conversation continues to happen at a federal level, at a state level, at a local community level. And what's unique about Washington is that we're also able to bring the investments to staff members, to people. So, we've actually hired people to be able to work through some of these issues. We put investments in the very programs on environmental health and the programs around climate change.

So, it's really about communicating, it's listening, it's the messaging. But I think the most important thing is to create the space for our staff members, and even our partners, to be able to come together and say, "There is something, there is a problem, and we've got to work on it."

JOHNSON:
What about the team implementing these ideas? Did any of them require new training?

SHAH:
Well, yeah. I mean, it depends on who they are, right? So, if you've gotten newer people that maybe haven't been in the space, and you do, you may need to actually train them. And what we have been doing is to work towards recruiting people.

So, one of the things that you and I have talked about previously is that our cornerstone values at the department are equity, innovation, engagement. So, when we have three cornerstone values and equity is the first value, it is not surprising that, when we're hiring people, we want to make sure that we're hiring people who understand that equity is important to us as an agency. And we want people to recognize the importance of innovation, we want people to recognize the importance of engaging partners and community members as well as each other.

So, all of that comes together. Newer people may have some of that environmental and that health equity training, and that's great; but we also want to make sure that we continue to provide our staff members the tools so that they can be ready for this changing system that all of us in public health are really a part of.

JOHNSON:
So, are you tracking every climate event and then doing some kind of overlay with other issues where you've identified health equity concerns? How are you doing this?

SHAH:
Yeah, it's a combination of looking at what the assets and resources are across the state and then trying to map it into where we're projecting—for example, future heating degree days, cooling degree days—and trying to put those projections, from a climate standpoint, onto where the assets are. Or where there may not be assets, right, where you're missing something.

And then, working with other agencies, whether it's at the state level or local level, and say, "Here's where the maps are. Here's where the visualization is. Here's where we are seeing either opportunities or gaps." And we've got to work together on trying to, you know, try to fill those gaps.

JOHNSON:
We can't forget about partnerships. How do those figure into this equation?

SHAH:
Well, yeah, absolutely. You know, I'd be remiss if I didn't mention our local health departments, our local public health. As you know, I spent the vast majority of my career in public health in a local health department. And you know, it happens on the ground, it happens in local communities. And so, we have to absolutely work with our local health departments in making sure that we're moving forward with our work.

In addition, we're part of an environmental public health tracking program that is working with our academic partners—for example, at the University of Washington. So, there's a lot that we're doing when it comes to local partners, community partners, as well as what's happening in our academic and private partnerships.

I do want to just make one quick comment about community because, ultimately, we've got to also make sure that our work is visible to our community members. And that means not just people who are representing community, but also the end user, the end community member. And so, that means oftentimes community-rooted organizations. And so, we're really making sure that we're taking an active role in how do we involve community with listening sessions, and really working around what does climate really truly mean to your health and wellbeing, for your family. And that's the kind of thing that people really—it resonates with them, but also it helps them really understand what's happening around our environment, and how that may impact their community.

JOHNSON:
Some of your colleagues can outwardly make this connection, others maybe politically are not able to do that. What is your advice to everyone listening about how to approach connecting climate change and health equity?

SHAH:
Yeah, I think we have to stay focused on public health, and we have to stay focused on what the science shows us, the data show us. I think we have to also remind ourselves that no matter what the environment is, whether it's a more blue environment, a more red environment, maybe an environment where we may have less receptivity for the words even, "climate change" or "the impact of climate on health," that we have to engage people. That may be our policymakers, that may be partners on the ground, and maybe each other.

But ultimately, there is so much work to be done. Let's not get stuck in the left-right dynamic, the political piece where—ultimately, we know public health is political, but we've got to be able to rise above that. And so remember, Robert, I was in a different state. You know, I came from a place where there are different ways of looking at the world and looking at the nomenclature of climate change or climate and health. And yet, even there, we were able to do so much.

Anybody in public health cannot just say, "Look, I can't do anything here." There's something you can always do. There's always something. Whether it's recycling, or whether you're, you know, going to try to talk about the business interest or the financial reasons that we're doing certain things, whether we're turning off our lights, whether we're doing certain things to catch water and making sure that we're reusing that water—there's so many green-friendly and environmentally-friendly, sound things that we can do ourselves as public health agencies, and public health leaders, and articulate that to our communities.

So, I think no matter where you are—whether east, west, south, north, whether it's, you know, communities that oftentimes may not be thinking about this—I will say the one thing is that all of us have been impacted by climate and its impact on health.

JOHNSON:
Rad Cunningham manages the climate change and health section at the Washington State Department of Health. He says there's no doubting the disproportionate effects of climate change on people already facing a mountain of daily challenges.

CUNNINGHAM:
So, when I'm trying to talk about that, I just want to make sure that people understand that the people who are getting impacted first and worst by environmental conditions in general—those environmental conditions are just being exacerbated by climate change, so those same environmental justice communities are often the ones that are being impacted first and worse by climate change.

And climate change is unique risk. So, it's not going to be exactly the same. But you know, there are, you know, where the flooding is a risk, where wildfire smoke is a persistent problem, you know, where there's not a lot of resilience to extreme heat—those are areas where we think people are really the most vulnerable. And we want to, you know, access those areas' person. Same with our homeless population. So, we have a homelessness coordinator now with DOH, and we've been coordinating with that person, just making sure that those populations are—you know, it's hard to reach them, it's hard to get services to them—we want to make sure that we think about that group when we're planning all of our rest of our programming.

JOHNSON:
Thinking about planning, how do you integrate health equity into your climate policies there in Washington?

CUNNINGHAM:
Yeah, so, I think the most important piece of integrating health equity in the climate policy is community engagement. So, reaching out to communities and listening to what they say. And sometimes that's really open ended. Because if you really want to let them drive these, you know, how we do climate resilience, you've got to go to them with an open mind, and not with a plan that's 90% done, right. So, we want to make sure we get to those communities, you know, engage those communities through partnerships.

So, one thing we've heard through a partner we work with, which is Front and Centered, which is a—Front and Centered, they've called themselves a grass tops organization, where they, you know, they're connected with a lot of the grassroots organizations, but they sort of, you know, engage with all of them. And when they talk to us, sometimes they say, "Department of Health, we need to have this conversation and you can't be there, because it's going to change the discussion in the room."

And so sometimes, you know, we need to partner just to be able to listen, or be able to create a space where we can listen appropriately to the concerns of the communities. And then, we need to demonstrate that we are listening and responding to that. And that's how we start building trust.

And so, that's kind of the approach we're starting to take. But that's a long-term approach. And so, we're a relatively young program, and we're building the foundation for doing that well, but it takes some time.

JOHNSON:
Who do you partner with in all of this? Is it mostly organizations that are interested in equity and environmental justice, or do you broaden that out a little bit and work with organizations that maybe don't have those terms in their names?

CUNNINGHAM:
That's a good question. So, one of the things we've worked on is this climate health adaptation initiative, and that's a group that we bring together—various state agencies and federal agencies. So, EPA attended those meetings, so does the Federal Reserve Bank of San Francisco, Health and Human Services.

And what we're trying to do in that group—and those groups, you know, they all care about environmental justice, but it's not in their name—but we are trying to work together to figure out what are the resources we can provide as state and federal governments to these local communities so that, by the time we go to the communities, we're not just asking them, "Hey, what are your concerns?" But we're saying, "Hey, what are your concerns, and here are the resources we have for you right now." Like, here's what we can do, and making sure that we're not, you know, performing an extractive process to say that we did community engagement, but like earnestly engaging with communities in a way that's going to benefit them and let them drive the climate resilience work.

JOHNSON:
What are some of the challenges that you've encountered or identified to date?

CUNNINGHAM:
So, I think a great example, I think—as you know, we worked with Pierce County, and we, you know, pulled together these climate partners in Pierce County. And, you know, Pierce County, there's a county climate resilience plan, the city of Tacoma has a climate resilience plan, and there's a sustainability plan.

We had all the partners in the room, but nobody had read all three plans, so that coordination piece was really missing. So I was like, "If nobody in this call has read it, then nobody's read that whole set." And so, getting that coordination piece is really critical. And it's one of the roles I think public health is uniquely able to play, making sure we have that coordination piece.

So, in a lot of what we're trying to do is build our coordination capacity. So, we have our climate justice coordinator and a climate change coordinator, and they are full up with that coordination work. So, we're looking to try and expand the staff and capacity we have there to make sure we have someone who's read all those plans, that can kind of coordinate work in an area like Pierce County, or maybe facilitate Pierce County getting somebody who can do that coordination of work.

So, that's one major challenge. Another one is climate change is so interdisciplinary. So, you know, there are people who work on, you know, permafrost and wildfire smoke and air quality and water quality, and, you know, extreme heat, you know, emergency response, vector-borne disease—it gets really hard to kind of pull all that together. And when you pull people together from that many different facets, the work can kind of go slow. So, I think that high-level coordination is needed to kind of bring all these groups together to move that stuff forward.

And the final challenge—and it's sort of a good one—is that the resource environment is changing. So, climate change and health was not particularly well-resourced, historically, in the public health field. But that's sort of changing in Washington State, and also through some federal programs that are available. And not a lot of the money has hit yet, but a lot of the opportunities and options are kind of showing up. And I think it's really, over the next five years, there's going to be a pretty massive change in what the public health community is going to be able to do on climate change because of these new opportunities coming up. So, that's really exciting.

JOHNSON:
Are the teams in your department already dialed in, or have you had to train them about the connections between climate change and equity?

CUNNINGHAM:
Yeah, I think both of those are areas where lots of people never undergo. Like, I'm personally still working on training myself on, you know, making sure I understand the equity implications of climate change. And, you know, I'm in a climate change general club, and in our staff meetings, every other staff meeting, we discuss racial justice and equity resources.

So, we're learning ourselves. But we also are taking on that role of trying to educate others in the agency around it. So, we have other parts of the agency, they're working in climate sensitive areas, you know, like our office of drinking water, our shellfish protection program, emergency management response. We want to make sure that we're talking with those groups, and they're building their capacity too, so it's kind of something we're working on all together as an agency. And so, there's a lot of cross training going on.

But it's also just bringing new staff on. So, I hired an epidemiologist recently who's starting tomorrow, actually, which is really exciting. And she's a great epidemiologist, and has worked in infectious disease for a bunch of years, but we're gonna have to train her on climate change. And there aren't a lot of people when you put out hiring notices who come in with a lot of climate change and public health experience at the same time. So, you gotta hire the climate change person and teach them public health, or hire the public health person and teach them climate change.

And so, one of the reasons I like the office and just the agency I work in is that our director says, you know, the values are that we care about each other and we're always learning. And I think this climate change is a perfect place to be if you were in an environment like that, because both of those things are necessary.

JOHNSON:
What about lessons learned? Do you have any that you can offer right now?

CUNNINGHAM:
Yeah, this one is a little tongue in cheek, but I think it actually can be helpful for some areas, which is, I've got a two-step process for starting a climate section for free. And the first one is you identify some people in your agency that are working on climate-sensitive risks—air quality, wildfire, smoke, flooding, drought—and then pull them over into a section and name them the climate health section. So, you know, part of that is just naming the work. And so that's one recommendation I have is that, you know.

In 2021, over 200 medical journals signed an op ed where they called the failure to act on climate change is the biggest threat to public health. So, if we're not resourcing that risk as a public health community, we're contributing to that risk that those academic journals are calling out. So, I think it's really important to start addressing climate change head on and not sort of like a little bit from emergency management and a little bit from environmental justice and kind of walking around the issue, but really setting up a program and starting to get it going.

JOHNSON:
As we close the conversation and the podcast, tell me what is the best argument, in your view, for doing a program like the one you have there in Washington State?

CUNNINGHAM:
You know, I think when you're talking about like climate and environmental justice, the things we need to change in order to address climate change are, you know, our transportation systems and our public health systems and our environmental health capacity issues. We need to change all those things anyway to address the history of racist, you know, public health and planning policies.

And so, we have a chance to not only address those historical inequities, but respond to the greatest public health challenge of our generation at the same time. And that's a challenge, you know, that I would like to see public health really rise up to. I think we can be the champions and the conveners of this climate health space. And you know, the studies all show that the public health messaging, the health connection and climate change is the one that speaks to people, especially people who aren't already all bought in on climate change. So, we can really be the messengers on that adaptation that we need to do and sort of on that piece where you get to address some of the historic inequities that public health has been either directly or indirectly involved in.

JOHNSON:
Thank you for listening to Public Health Review.

By the way, did you hear the slight thumping behind some of Rad's comments near the end of his interview? Those were Washington's finest squirrels playing on the roof of Rad's office. No doubt they're concerned about the climate, too. We were glad to have them join the show.

If you like what we're doing here, maybe take a minute to send the episode to your colleagues on social media. And if you have comments or questions, we'd like to hear from you. Email us at pr@astho.org. That address again, P-R at A-S-T-H-O dot org. You can also follow us using the Follow button on your favorite podcast player.

This show is a production of the Association of State and Territorial Health Officials. For Public Health Review, I'm Robert Johnson. Be well.